Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention.

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Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs. CHANGE 2 was available to Medicaid patients with diabetes and hypertension whose primary care homes were part of a care management network in the Northern Piedmont region of North Carolina. CHANGE 3 was available to low-income patients receiving care in three geographical areas with multiple chronic conditions at low or moderate risk for developing cardiovascular disease. Adaptations were made to ensure fit with available organizational resources and the patient population's health needs. Data available for evaluation are presented. For CHANGE 2, we evaluated improvement in A1c control using paired t test. For both studies, we describe feasibility measured by percentage of patients who completed the curriculum. CHANGE 2 involved 125 participants. CHANGE 3 had 127 participants. In CHANGE 2, 69 participants had A1c measurements at baseline and 12-month follow-up; A1c improved from 8.4 to 7.8 (p = .008). In CHANGE 3, interventionists completed 47% (n = 45) of calls to enroll participants at the 4-month encounter, and among those eligible for a 12-month call (n = 52), 21% of 12-month calls were completed with participants. In CHANGE 2, 40% of participants (n = 50) completed all 12 encounters. Thoughtful adaptation is critical to translate clinical trials into community-based clinic settings. Successful implementation of adapted evidence-based interventions may be feasible and can positively affect patients' disease control.





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Zullig, Leah L, Felicia McCant, Mina Silberberg, Fred Johnson, Bradi B Granger and Hayden B Bosworth (2018). Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention. Translational behavioral medicine, 8(2). pp. 225–232. 10.1093/tbm/ibx030 Retrieved from

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Leah L Zullig

Professor in Population Health Sciences

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research


Mina Ruth Silberberg

Associate Professor in Family Medicine and Community Health

I have thirty years of experience in health services, community health, and health policy research and evaluation.  My work has focused on improving the health of low-income and otherwise underserved populations through primary care practice change, community-based programs/organizations, and addressing social drivers of health.  My studies generally use mixed-methods participatory program evaluation and community-engaged research approaches. I also study, write about, and teach community engaged/participatory research and evaluation.  I have a great deal of experience with mentoring trainees on research, including undergraduate students, graduate students, medical students, residents, junior faculty, and senior faculty moving into new areas of work.


Frederick Salvatore Johnson

Assistant Professor of the Practice in Family Medicine and Community Health

Population Health Improvement

Correlation of Health and Social Determinants

Poverty, Race and Chronic Trauma

Social Capacity and Community Engagement

Community Health

Chronic Disease Care Management and Clinical Delivery Systems

Patient Self Management and Self Efficacy

Community Resource Design and Development 

Community Health Informatics         

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